One state eyes increasing telehealth in community health centers

Stakeholders in Massachusetts are waging a campaign to accelerate telehealth use among the state’s network of community health centers.

The Massachusetts Federally Qualified Health Center Telehealth Consortium has launched the second phase of an initiative to increase access to telehealth services in under-resourced and medically vulnerable communities.

The program received nearly $5 million from the Federal Communication Commission’s Connected Care Pilot Program, as well as support from private donations and the state’s Department of Public Health.

Christina Severin, president and CEO of the Community Care Cooperative, a consortium partner, said the effort began last year as a way to maintain access to patients after they shut down in-person services during the pandemic.

Nationwide, community health centers have greatly increased their use of telehealth over the past year. Figures released last June by the National Association of Community Health Centers found 98% of health centers reported using telehealth or telephonic services at some point during the pandemic.

Despite those improvements, community health centers still face a number of challenges to fully adopt telehealth within their models of care moving forward. A lack of infrastructure limits broadband access to clinics and patients located in rural parts of the country, while the cost of high-speed internet service makes it unavailable for the more than 90% of community health center patients who live in or near poverty.

During the first six-month phase of the campaign in Massachusetts, 35 participating community health centers saw revenues reach 80% of their pre-pandemic levels.

The consortium provided the CHCs and patients with cell phones and tablets, educational and technical support, and developed best practices for integrating telehealth in their services.

Severin said the second phase will concentrate on making telehealth a more permanent part of community health centers’ care delivery model.

“When we emerge into whatever new normal healthcare will ultimately look like [post pandemic], we don’t want to go back to the way healthcare was delivered, which was almost all face-to-face medicine,” Severin said. “For patients served by community health centers, face-to-face medicine is not always the best option.”

Severin said telehealth resulted in a steep decline in appointment cancellations among patients in the consortium, falling from an average rate of 20% before the pandemic to nearly zero. The group will hire more staff to serve as ‘digital navigators’ who help patients address any financial, clinical or technical challenges they may face in accessing telehealth services.

Telehealth was largely unused by the vast majority of community health centers prior to the pandemic. A study published last June in Health Affairs found 56% of the more than 1,300 centers studied did not have any telehealth use in 2018, while 47% only used it to speak with medical specialists instead of patients.

Severin said the campaign now will seek to address some of the more upstream obstacles hindering the expansion of broadband internet access among poor households and communities of color. Such issues include advocating for keeping in place regulatory changes made by CMS as part of the public health emergency that allowed providers to get reimbursed from Medicare for telehealth at the same rate as in-person services.

“Our highest level objective in this project is to make immediate investments now so that we can rebuild a health system for community health center patients that can deliver more health equity than before the pandemic,” Severin said.


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